Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Paralysis agitans ++ 332.0 Paralysis agitans ++ G20 Parkinsonism (idiopathic) (primary) ++ 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System +++ Description ++ Progressive degenerative disorder of the central nervous systemDeath of dopamine-producing cells in the substantia nigraNamed after English MD, James ParkinsonParkinsonian syndromes (4 types)Primary or idiopathic, no known causeSecondary or acquiredHereditary parkinsonismParkinson plus syndrome or multiple system degeneration +++ Essentials of Diagnosis ++ Core features include a tetrad of hypo- or bradykinesia, resting tremor, postural instability, and rigiditySome people have a rigidity-dominant presentation; others have a dyskinesia-dominant presentation (predominantly those with onset at a young age)Pathophysiology +++ General Considerations ++ Positive diagnosis of PD is made with a successful levodopa (l-dopa) trial +++ Demographics1 ++ Onset generally between 45 to 70 years of ageMore common in menImpacts all ethnic groups and socioeconomic classesMost cases are idiopathic; genetic variants exist, but are rare +++ Signs and Symptoms ++ Tremor: usually asymmetricalGait disturbance, usually described as “festinating”Postural instabilityStooped postureStiffness/rigidity: begins on one sideSlowness of movementDizzinessFreezing of movementBradykinesia or hypokinesiaMuscle acheLoss of dexterityMask-like facial expressionMicrographia (small, cramped handwriting)DepressionNeuropsychiatric problemsSpeech disturbance: decreased volume and pitch, as well as motoric lossDementia in the later stages of the diseaseLoss of smellConstipation +++ Functional Implications ++ Progressive loss ofBalance reactionsAmbulation ability and safetyRespiratory capacity to support activityInteraction with home and community environments +++ Possible Contributing Causes ++ UnknownDrug-induced parkinsonism (DIP) +++ Differential Diagnoses ++ Hemiparkinson-hemiatrophy syndromeProgressive supranuclear palsy (PSP)Basal ganglia tumorsVascular pathologyMultiple system atrophy (MSA)Lewy body diseaseCorticobasal ganglionic degeneration (CBGD)EncephalitisPseudobulbar palsyBinswanger’s diseaseNormal-pressure hydrocephalus (NPH)Multiple sclerosis (MS) +++ Laboratory Tests ++ Blood test to help rule out other disorders +++ Imaging ++ Positron emission tomography (PET) scanMagnetic resonance imaging (MRI) and Computed tomography (CT) usually normal +++ Diagnostic Procedures ++ Confirmation is made by a positive response to l-dopa trial in a patient with the tetrad of symptoms brady- or hypokinesia, resting tremor, postural changes and instability, cogwheel rigidity ++ PET scan would demonstrate decreased activity in the basal ganglia +++ Medications ++ Sinemet®RopiniroleSymmetrel®Cogentin®EntacaponeRasagilineSelegiline ++ To neurologist for imaging; disease managementTo neurosurgeon for deep brain stimulationTo the National Parkinson Foundation for support ++ ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.